Encore veiwer results with questions

[detcord]

I've been on APAP for 4 months now, and this is a pretty normal night for me. I had a home sleep test and a home titration with my machine. My 90% pressure was 18, so this is the spear I set after that. My AHI has always hovered around 7 or 8, occasionally tending up to 10 or 11 at times. Wake up feeling good, but still want/need to nap in the afternoon. I believe I can do better. Just got the software and wondered what everyone thought I might improve on.

[DoriC]

Have you tried straight cpap mode at a set pressure?

[slaaplekker]

I guess I'm happy with my AHI of 0.2 but I still need naps too so I'm not sure that is an indication of anything.

Seriously I think APAP is not the right therapy for you. Others with more experience can probably offer more information but I'm guessing you need a BiPap for those higher pressures.

One thing to try is to get a recording Oximeter. Search the site there are lots of discussions about where to buy one and what to buy. Or go back to the doctor and get one for an overnight Oximetery - my Dr charges $50 for that. That will tell you more of what is going on during all of those events that are showing up on your reports.

Good Luck
John

[rested gal]

Seriously I think APAP is not the right therapy for you. Others with more experience can probably offer more information but I'm guessing you need a BiPap for those higher pressures.

I don't have more experience, but I agree absolutely. A bilevel machine (Philips Respironics BiPAP Auto or ResMed VPAP Auto 25) is what I'd want, if it were me. I'd probably run either of those in just bilevel mode for awhile, not in autotitrating bilevel mode. At least until I got quite a bit of data using just "bilevel."

The way you're hitting the highest pressure a CPAP or Autopap can offer, detcord -- a pressure of 20 -- I'd definitely want to be using a bilevel machine. Bilevels can go higher than 20, if needed. And at such high pressures, I'd certainly want the kind of exhalation pressure relief of a bilevel. Neither EPR/EasyBreathe nor C-Flex/A-Flex in autopaps can give the kind of pressure relief the way a true bilevel machine can.

You are very fortunate that you have such a nice low (considering the high pressure) leak rate, detcord. You're ahead of the game on that, lucky you!

[DoriC]

I would think Bi-Pap is what you'll need but in case you have to convince anyone (Dr,Insurance,DME) to make the exchange,I thought it might be a good idea to prove you've tried both Apap and Cpap settings.

[Janknitz]

Detcord,

Are you working with a physician at all? Was your 90% pressure on home titration the only criteria used to determine the pressure range in APAP?

You certainly look like you may be needing a bipap as you are bumping up against the maximum pressure of 20 quite a bit.

Some leaks are being detected, even though the "green line" is solid across the top of the leak chart--e.g. it's reporting 3 min of LL and .2% of the night in LL--these should both be O. What are the normal pressures for your mask at that flow rate? You may have some leaks to get under control.

[semreka]

my friend,
according to me your leak values are too high.
most probably you are opening your mouth.
your AHI value ought to be lesser than 5.
keep your machine in auto mode.
you have no Vibratory Snores (VS) so you may reduce your min pressure values step by step.(each night 0.5 cm or at most 1.0 cm H2O)
while you are doing this check your VS values .If you observe VS values more than 10 stop reducing min. pressure.
Lesser pressure value will supply you some more comfort and may help you to keep your mouth closed.And your AHI values will drop.
If you do not observe any development in your result of AHI , after taking the precautions above , you may think to change your mask to full face type of mask or you may try a chin strap .
You are not using the air supplied by the machine for keeping your throat open.Because of open mouth.
If the advices above do not work for your case , find a way to keep your mouth closed.
You should concentrate on this.
Good luck..
God Bless..........

[sepool]

Here is a link to your expect leak rate for your mask:

http://www.resmed.com/us/assets/documen ... sa_eng.pdf

It does look like you have your leaks in good control.

I might try changing your pressure range from what looks like now from 16-20 to 18-20.

If you have mouth leaks, it sure doesn't show here. Do you wake and find your mouth dry?

If indeed you need more than 20, you need a different machine, but I'd try higher pressures in the mean time.

[detcord]

I both tape and chinstrap, with no dry mouth in the AM. Home titration was all I had to use for a pressure range. I am going to schedule an appointment with my Doc, to hopefully make sense of this. My AHI last night was 13, with OA's and Centrals all over the place. I show Vibratory Snores at 15.5 so set the low range at 16 for now. I'll keep trying, and eventually get this right.

[akcpapguy]

You really need to go have an attended sleep study (read in a sleep lab) with titration done. All you are doing right now is putting lipstick on a pig which is dressed in sheeps clothing.
This is a prime example of what is wrong with the "Home study/titration only" model.


AKCPAPGUY

[semreka]

Here is a link to your expect leak rate for your mask:

http://www.resmed.com/us/assets/documen ... sa_eng.pdf

It does look like you have your leaks in good control.

I might try changing your pressure range from what looks like now from 16-20 to 18-20.

If you have mouth leaks, it sure doesn't show here. Do you wake and find your mouth dry?

If indeed you need more than 20, you need a different machine, but I'd try higher pressures in the mean time.

the link shows the flow rate discharged from vents of the masks .
Can you please explain the relation between the allowable leak and this value ????
If you find a relation between them , this information will be useful for us to determine the system one settings in respironics machines for the resmed masks .
Thank you ...

[detcord]

I Agree about home titration, but unfortunately that's what my insurance company would pay for. Now if I can't get this working, maybe they will. Don't know.

[detcord]

Here's last nights info, leaks not great, any suggestions as to whats going on?

[sepool]

Here is a link to your expect leak rate for your mask:

http://www.resmed.com/us/assets/documen ... sa_eng.pdf

It does look like you have your leaks in good control.

I might try changing your pressure range from what looks like now from 16-20 to 18-20.

If you have mouth leaks, it sure doesn't show here. Do you wake and find your mouth dry?

If indeed you need more than 20, you need a different machine, but I'd try higher pressures in the mean time.

the link shows the flow rate discharged from vents of the masks .
Can you please explain the relation between the allowable leak and this value ????
If you find a relation between them , this information will be useful for us to determine the system one settings in respironics machines for the resmed masks .
Thank you ...

The chart shows the expected leak rate for the mask at different pressures. I believe this is the same as the allowable leak. The report given by the original poster had a graph called "Total Leak". I assume this would be the expected (allowable) leak, plus any extra leaks. His graph matches the expected leak rate very closely.

However, I don't know anything about the mask settings on the system one and what they do. What little I have read in this forum is that the mask resistance settings have nothing to do with the expected vent rate.

[semreka]

Here's last nights info, leaks not great, any suggestions as to whats going on?

This is not the problem related with insurance or other procedures related with money.
This is a problem directly related with your health.
Everybody in this story including yourself and your insurance company should determine the priorities based on this principle .
They have to fill your needs.
You are client.
And you have a report in your hand which shows your treatment is wrong.
If insurance company decides the doctor for you , you can claim an other doctor.
If you decide the doctor, go and kick the suitable part of your doctor's body . He should pay your expenditures for a new doctor and sufficient machine ( most probably a Bipap).
For them the issue is related with money , but for you the issue is related with your life.
They earn enough they can spend for you some more.
I wish you luck and
I wish them gumption and conscience...
GOD BLESS